Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Phone *

(###)

###

####

Player Name *

First Name

Last Name

Player Birthday *

MM

DD

YYYY

Player Phone

If applicable

(###)

###

####

Emergency Contact *

different from above

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Checkbox *

Summit Soccer will be posting soccer/camp related content to our social media pages. Videos and photos will be used to demonstrate technique, skill and positive coaching. Please give your permission to post soccer-related footage of your athlete by checking the box. Please note your athlete's full name will not be used in the post.

Click to give permission